Toujeo vs Lantus, Toujeo Costs, Insulin Glargine

It’s understandable if you are wondering about the difference between Lantus® and Toujeo®. After all, both Lantus and Toujeo contain the same insulin, called insulin glargine. Insulin glargine was introduced in the year 2000. This was a huge advancement because it was the first long-acting basal insulin. Before the development of insulin glargine, doctors did not have many types of insulins to choose from.

Insulin Glargine: Toujeo vs Lantus

Glargine (the insulin in both Lantus and Toujeo) is an insulin analogue—meaning it has been modified from regular insulin to change its structure and the way it is absorbed. Insulin glargine is still available in its original formulation as Lantus, most commonly prescribed as the Lantus Solostar® pen. Insulin is classically prescribed at a very specific concentration called U-100. The U stands for units. The 100 stands for the number of units present in the liquid (1 milliliter). U-100 insulin has 100 units in 1 milliliter. U-100 is also referred to as “regular” insulin, but this can be confusing since many different types of insulin come in this concentration.

Fast forward a decade and a half later, and insulin glargine (originally Lantus) has reinvented itself. Toujeo (U-300) insulin glargine was approved by the FDA in late February of 2015, making it the first long-acting concentrated insulin available on the market. It is available in insulin pen form only as the Toujeo SoloStar. What researchers discovered was that if they made glargine more concentrated, it lasts slightly longer in the body. That’s right, Toujeo IS GLARGINE, just in the concentrated form of U-300. This means Toujeo is three times more concentrated than Lantus. Some people think Toujeo is stronger than Lantus, but this not true. Toujeo is more concentrated than Lantus, but this does not make it a stronger insulin (learn more about concentrated insulin here). Three times higher concentration means that the same amount of liquid (one milliliter) contains three times the amount of insulin. Toujeo is more concentrated, so the amount (or volume) of the injected medicine is three times less than that of Lantus, but the strength of the medication is the same.

Toujeo IS GLARGINE, just in the concentrated form of U-300. This means Toujeo is three times more concentrated than Lantus. The amount (or volume) of the injected medicine is three times less than that of Lantus, but the strength of the medication is the same.

What are the key differences between Lantus vs Toujeo?

Lantus is available in both a vial and the pen form, while Toujeo is only available in the SoloStar pen.

Toujeo is three times the concentration as compared to Lantus.

The changes in the concentration of Toujeo (as compared to Lantus) have prolonged its absorption, and it therefore lasts slightly longer in the body.

Some studies suggest that the changes in the concentration of Toujeo have led to a decrease in the amount of hypoglycemia that occurs as compared to Lantus (approx. 30% less).

Studies show that the dose of Toujeo may need to be 10-15% higher to get the same fasting sugar control as compared to Lantus.

Toujeo: Common Questions

How long does Toujeo last in the body?

Toujeo is in a class of insulin called long-acting basal insulin. Toujeo’s onset to action is 5 hours or longer. The half-life of Toujeo is 19 hours, and it lasts for a little longer than 24 hours in the body. It seems that by increasing the concentration of glargine, the absorption is prolonged, allowing Toujeo to last a little longer under the skin. The change in the concentration also causes Toujeo to need more time to build up in the body. It takes at least 5 days to reach a steady state. This means that the original starting dose really should not be increased until the medication has had time to reach its full effect.

Should I lower my insulin dose when I change from Lantus to Toujeo?

No. Despite the fact that Toujeo is three times more concentrated than Lantus, it is converted on a 1:1 basis. Meaning if you are on 22 units of Lantus and your doctor changes you to Toujeo, your dose will likely be 22 units. In fact, you might start at the same dose, but the studies show you are likely to need 10-15% more Toujeo to achieve the same blood sugar control. In studies, patients who were changed from another long-acting insulin to Toujeo required (as compared to Lantus) higher doses to get the same early morning sugar levels.

What will happen to my HgbA1c if I change to Toujeo?

Studies suggest that the hemoglobin A1c (HgbA1c, A1c) drop on Toujeo is similar to other basal insulins. In a series of studies called EDITION that compared Toujeo to Lantus , the average three-month blood sugar drop was similar to Lantus.

How much insulin does the Toujeo SoloStar Pen contain? (vs. Lantus)

The Toujeo SoloStar pen contains 450 units of insulin, while Lantus has 300 units in a single pen. There is no need to do any fancy calculations while using the Toujeo Solostar pen, as the pen was designed to take into account that the insulin concentration is higher and does the math by giving smaller volumes per click.

How many pens are in a box of Toujeo? (vs. Lantus)

The Toujeo SoloStar pens come three in a carton. Lantus comes as five pens per carton.

How much does Toujeo cost? (vs. Lantus)

Three pens of Toujeo costs approximately $358.24, or 0.27 cents per unit. Five pens of Lantus costs approximately $397.16, which breaks down to 0.26 cents per unit.

How should the Toujeo pen be stored?

Both Toujeo and Lantus SoloStar pens contain the same insulin glargine and are stored in a similar way. Pens that have not been used should be kept in the refrigerator. After the first use, both Toujeo and Lantus can be kept at room temperature. Both Toujeo and Lantus Solostar pens should be discarded 28 days after the first injection.

Cost

397.16 dollars

(5 pens)

358.24 dollars

(3 pens)

About the Author

Chris Palmeiro D.O. M.Sc.

Dr. Palmeiro is Chairman of Endocrinology at the HealthAlliance of the Hudson Valley, he also serves patients with intellectual and developmental disabilities at the Westchester Institute of Human Development in Valhalla, New York. He has a Masters of Science degree in clinical nutrition and is a diplomate of the American Board of Internal Medicine. His interests within the realm of endocrinology include nutrition support, obesity counseling and the progressive management of diabetes.